A comparıson of crystalloıd and blood ınductıon cardıoplegıa ın low - rısk patıents undergoıng coronary artery bypass graftıng
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Objective: Improvements in the application of cardio protective methods in open-heart surgery have been associated with decreased operative mortality, lowered incidence of perioperative myocardial infarction and improved cardiac functions. Material and Methods: One hundred consecutive patients undergoing their first elective coronary artery bypass grafting were prospectively randomized to receive either cold crystalloid cardioplegia (Group A, n: 50) or cold blood cardioplegia (Group B, n: 50). Patients in group A received initial cold crystalloid cardioplegia, patients in group B received initial cold blood cardioplegia that was a mixture (4:1) of the oxygenated blood of the patient and hyperkalemic crystalloid concentration. In both groups, following the inital cardioplegia, cold blood cardioplegia every 20 minutes and finally warm blood cardioplegia (37°C) was performed before the removal of the aortic cross clamp. Results: In both groups, the baseline patient characteristics did not differ. During the cardiopulmonary bypass, blood transfusion was applied to the bypass circuit 11 patients in group A and 2 patients in group B because of low hemoglobin level (p<0.001). Following removal of the aortic cross clamp, the incidence of spontaneous defibrillation in group A was lower than in group B (p<0.001). Creatin kinase isoenzyme MB level at the 12th hour postoperatively was significantly higher in group A than in group B (p<0.01). Perioperative Ml was in three patients in group A and 1 patient in group B, (p: not significant). The incidence of atrial fibrillation, ventricular extrasystole and low cardiac out-put was similar in both groups. Conclusion: Cold blood induction performs better myocardial protection and faster myocardial recovery than the cold crystalloid induction cardioplegia in low-risk patients undergoing coronary artery bypass grafting.